Creating Community

Pop Brixton, London

What do old shipping containers have to do with creating community? They can be re-purposed to provide sturdy protection for indoor gathering spaces, such as one I visited this past week in London.

Pop Brixton is an indoor-outdoor community space in the heart of the ethnically diverse south London neighborhood of Brixton (of David Bowie and Eddy Grant/”Electric Avenue” fame). Built of shipping containers on a previously empty, unused city lot full of concrete rubble, Pop Brixton is an incubator for community pop-up cafes, music and art events, an alternative school, a shared office/workspace (Impact Hub Brixton), a community garden, and even a community/people’s refrigerator named Freddie.  

“Freddie” the People’s Fridge

One of the Pop Brixton design features that struck me as being most effective was its central dining hall space with large, communal tables. This space was winterized when I visited, being enclosed and well-heated with portable gas heaters. Local artists (along with children from the neighborhood) designed and made the colorful banners hanging overhead, as well as the cleverly-constructed “fireplace” at the heart of the communal space. The fireplace is made of a plywood frame/”flames” with orange paper and lights—shown below in the two photographs. There were a few people sitting around engrossed with the solo glow of their smartphones, but the vast majority of people were talking and interacting in positive ways. 

Upstairs on the second floor (wheelchair accessible), was a lovely open seating area for quieter, more contemplative places for conversations (or nursing babies), surrounded by plants and more banners. 

Out back on the ground floor is the community garden (near Freddie the Fridge), the school, and the office-sharing/community-building space of Impact HUB Brixton. All of the small businesses housed in Pop Brixton are independent, with the majority being owned/operated by local community members. They actively promote social enterprises as well as having a Community Investment Scheme where all members donate at least one hour each week to use their time and skills to support local causes. 

One of the local agencies they support is Skye Alexandra House, a semi-residential home for vulnerable women aged 16-18 who have suffered abuse, imprisonment, prostitution, or disruptive foster care experiences. Pop Brixton supports their “Inspiring Butterflies” program, “a series of workshops that focus on personal development, life skills, awareness of sexual exploitation and domestic violence, bullying, money management, performing arts and enterprise.”

Pop Brixton is inspiring and welcoming and truly is a place where people make (positive, community-building) things happen. Out of boxes. 

Loneliness Kills

Living on my own in the kingdom of loneliness for over three months has made me more aware of the pernicious effects of loneliness on health and wellbeing. It does not surprise me that the U.K now has a Minister of Loneliness, and that Prime Minister Theresa May has recently released a loneliness policy report: “A Connected Society: A Strategy for Tackling Loneliness—Laying the Foundations for Change” (October 15, 2018). May calls loneliness a “great public health challenge” and plans to have GPs within the NHS to be able to refer patients to community programs geared to ease loneliness.

Yesterday, I visited a long-standing (36 years) community cafe in Edinburgh that has been successfully combating loneliness among the elderly and people living with mental health challenges Located near the Royal Edinburgh Hospital, a long-standing mental health facility in the Morningside area of the city, the Open Door Cafe is a most welcoming place. From the high school student volunteer, Hamish, who greeted me and served me a great cuppa’ and scone, to the friendly regular customer/patrons who shared their stories with me, this was a place that warmed my heart. It also gives me hope that we can open the community Doorway Cafe in the University District of Seattle along similar lines. They use a pay-it-forward model and also have a robust group of volunteers to keep the place sustainable. In addition, they receive some funding from the NHS.

It also warms my heart to have discovered that the Open Door cafe was founded by an Edinburgh nurse, Peggy Hunter, all the way back in 1982. She said, “I have a dream to turn loneliness into fellowship, isolation into recognition…” and she has done just that. 

I love their statement on their website in which they succinctly describe their cafe championing of diversity: “Of course, many people who use our services have a variety of support needs, so you may find having a cuppa is a different experience to that of your usual coffee shop. Can you open your mind to share some space with someone who is different from you?”

How the Poor (and Homeless) Die

Homeless encampment, Edinburgh cemetery

A powerful and classic (yet too little known) social justice writing by George Orwell is his autobiographical essay “How the Poor Die.” It should be required reading for all nursing and other health science students as it eloquently describes the experience of death and dying for poor and homeless people. Although the essay is based on his experiences, first as a poor patient on a public ward of a Paris hospital in 1929, and then back in England and Scotland (Glasgow) towards the end of WWII, there are echoes of truths in his observations that are relevant today. 

One of the most poignant parts of the essay describes “old numero 57” (patients were numbered, not named) lying—and dying—on a cot in the open ward next to Orwell. He writes, “They are treated like animals. They die alone, their organs already marked for a bottle in the museum, their bodies designated for dissection.” 

Orwell’s essay came back to me yesterday as I went in search of pauper’s grave sites in Edinburgh. From my research, it seems that there are thousands upon thousands of pauper’s graves in many of the town’s oldest remaining church cemeteries—such as St Cuthbert’s just below the Edinburgh Castle. They are buried in communal ( or, rather “mass”?) graves that are, of course, unmarked, and typically located in the now grassy central parts of the cemetery as shown in this photograph I took yesterday. There are older laws banning the grazing of sheep or cattle on these churchyard fields; current laws are posted banning all animals, including dogs (except for certified service animals). 

St Cuthbert churchyard

Edinburgh is infamous for its early to mid nineteenth century grave robbers, body snatchers, or “resurrection men” who dug up recently buried bodies of people and sold them to surgeons of the University of Edinburgh Medical School for their anatomy dissection. And then there were the body snatchers (and complicit surgeons) who took it even further, murdering poor and homeless men and women on the streets and in flophouses. People who died in poor/workhouses and public insane asylums and whose families did not claim (and pay for) their bodies were sold by the Overseers of the Poor to the medical schools for dissection. Is it any wonder that poor and homeless people have a well-founded fear of public hospitals and related institutions? 

A Call to Peace and Nursing

DSC00821Today, on this 100th anniversary of the armistice that ended the long bloody battle of World War I, I am reminded of the odd, and to me, unfortunate, relationship between war and nursing. Since I currently live in the land of Florence Nightingale, the lasting legacies of war nursing surround me.

From the Crimean War during Nightingale’s time, through the two World Wars, and on to the more recent wars in Afghanistan and Iraq, modern nursing developed alongside modern warfare. Of course, many medical advances have come from battlefield medicine. But nursing as an entire discipline (and only more recently a profession) in Britain came directly from wartime nursing practice. The legacies of this include a rigid, hierarchical, old-fashioned, and sexist nurse practice structure that is almost exclusively hospital based. The old-fashioned and sexist parts are how I view it, especially given the fact that British hospitals still have “ward sisters” and “hospital matrons.” And, nurse practitioners exist here in name only—they are not allowed to perform any of the expanded scope of nursing practice that we are able to do in the US. (Happy National Nurse Practitioners Week to all of you nurse practitioner colleagues back home. I have loved being a nurse practitioner now for a total of thirty-two years.)

How—and why—has American nursing developed in a different direction from that of British nursing? While I do not pretend to be an expert on the history of nursing, I imagine that the comparatively youthful cheekiness of early American nurse pioneers has something to do with our country’s diverging development of modern nursing. The American nurse pioneers like Dorothea Dix (mental health reformer/Superintendent of Women Nurses for the Union Army—if not a nurse herself she was certainly influential on nursing) and especially Lillian Wald, of Henry Street Settlement in New York City and founder of public/community health nursing.

Public/community health nursing does not and never has existed in Britain. Since public health/community health nursing and the expanded primary care role of nurse practitioner were what inspired me to even consider nursing in the first place—and are what continue to inspire me–I have come to realize that I would not be a nurse if I had been born in Britain or in any of the many countries which are former colonies of the British Empire (including Australia, New Zealand, and Canada.) Yet (and this is a big plus), the UK and these three countries/former British colonies all have some form of national health care. And, for the most part (Scotland where I am living is an exception), they all manage to have healthier populations overall for much less healthcare spending.

 

Note:

The photograph in this post is one I took in the Te Papa Museum, Wellington, New Zealand in 2016. It was part of an exhibition on WWI nursing and WWI’s effects on New Zealand in general. It was appalling to realize that entire populations of “fighting age” men (including Maori men) of New Zealand villages were killed in the war. WWI commemorative statues, along with the ubiquitous red poppies, abound throughout the tiny nation of New Zealand.

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A Cheeky American Nurse

P1020873Immersion experiences in another country, another culture, can bring out the best—and the worst—in people. While living abroad you cannot help but make moment-by-moment comparisons between where you find yourself and where you call home. Seemingly little things: if they drive on the left instead of the right as they do at home, which side of the sidewalk should you walk on? (Answer, at least here in the UK: there are no sidewalk etiquette rules. Expect complete chaos.) To deeper comparisons such as “Why are all British nurses forced into one of four possible specialties (Adult, Pediatrics, Mental Health, and Learning Disabilities) from the very beginning of their education?”  Is this Florence Nightingale’s legacy?

As a cheeky American nurse (and nurse educator) living and working in the UK, this British approach to nurse education is something I sincerely hope that American nursing never tries to adopt. There is much to admire about the UK healthcare system, with the prime example being the existence of the NHS—although imperfect, as are all healthcare systems, it is much loved and functions so much better than the US healthcare ‘system.’ It occurs to me as ironic that while the US healthcare system is more fractured than the British NHS, British nurse education is more fractured than is ours in the US. Or at least that is how it appears to me.

This British nursing forced specialization practice is a holdover from the days (not so long ago here) of hospital-based apprenticeship, diploma-level nursing. Of course, in the US, we have also had this form of nurse “training” that is fast being phased out. In the UK, there continue to be debates about the value of a higher education degree for nurses, with some people arguing that university degrees are responsible for the apparent diminishment of empathy among British nurses. Empathy cannot be taught, but it certainly can be encouraged and modeled. I do wonder: how well can that happen in any nurse education model based primarily on traditional lectures with a class size of upwards of 700 (or more) students and multiple cohort intakes and graduations each year? That is the current reality of nurse education in the UK. Mass marketing of (or attempts to teach) empathy not only do not work—they have the opposite effect.

Notes:

  • The photograph included with this blog post is one I took in London last month at the excellent Wellcome Collection Museum. Even if you cannot visit this museum in person, check out their website for amazing online resources, including their six-part series, “The History of the NHS.” 
  • Although I am currently situated at a UK School of Nursing, I first learned about the strange (to me) structure of British nursing from two non-fiction/memoir books: 1) The Language of Kindness: A Nurse’s Story, by Christie Watson (London: Chatto and Windus, 2018 and 2) One Pair of Feet, by Monica Dickens (yes, related to ‘that’ Dickens), (Middlesex: Penguin, 1946). Monica Dickens’ book is based on her brief stint as a hospital nurse apprentice during WWII. Christie Watson’s book is based on her twenty years’ work as a pediatric nurse in London hospitals. I highly recommend Watson’s book, but not the one by Dickens unless you are a WWII buff of some sort.

Goodbye Facebook, Hello (real) Books and Real Community

IMG_5410My relationship with Facebook and other forms of social media began eight years ago. I was a late adopter of social media and only got into it at the urging of various writing teachers and coaches. “Find your voice!” “Build your author platform and social media presence!” For the first years of my having a Facebook account, it was solely a a way to share my blog posts on this Medical Margins website. All fine, but then Facebook began to suck me in with its insidious tentacles of an addictive reward system: “Like my posts! Like my books! Like me, like me!” And the equally powerful addiction to the activating qualities of stress, reading posts (real or fake, who knows?) like “The world is on fire! Trump did this, said that! The sky is really falling you silly Chicken Little!” Suddenly, the people I was following most closely were beginning to add posts like “How much drinking is too much?” I knew it was time to step away from the screen.

I recently took a refreshing break from Facebook, having it coincide with a study abroad experience. One of the first things I noticed was a changed (and healthier, I might add) renewed relationship with the world around me. That gorgeous, unknown-to-me purple plant growing out of an ancient stone wall along the Water of Leith in Edinburgh? Ah yes! No need to quickly pull out my iPhone and snap a photo to add to Facebook or Instagram or Twitter or whatever. Stop and admire the plant and not feel the need to instantly share it with the world. (Although, yes, I will share it with you in this post.)

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What I told myself as I stood there contemplating this flower. Stop. Wait. Listen. Notice the people walking by on the river walk path. Notice the trees rustling in the wind. Notice the squawking ducks begging children for bits of bread. Notice the wee public library just up that cobblestoned street. Go into that library and see what’s on offer.

The newly converted, cleansed, on the wagon folks of any sort can be quite insufferable, so I will spare you the platitudes. I do recognize the positive uses of Facebook and social media—finding old friends in far-flung reaches of the world, checking on the ‘safe’ status of a friend in the eye of a hurricane, rejoicing in a friend’s success in whatever they find successful. Virtual communities can be powerful sources of information and support for people, especially for marginalized groups. But they are just that—virtual. When they take the place of actual face-to-face, in the local library or corner cafe community-based interactions, that is when skewed realities and misunderstandings and deep divisions flood in and take over our lives.

For now at least, I am officially off most all social media platforms. I have broken up with Facebook and you can find me either in the local library (where I am writing this and channeling my repeat visits to the Mother of All Libraries in the photograph above—the British Library) or at a community cafe.

 

No Time to Be Silent: On Radical Nursing

P1020860There is a time and place for silence, but only when it is freely chosen, not imposed. But now is not the time for silence. Now is the time to step us, speak out, and, at least in the United States, to vote. It is time to remember that progress on human rights and social justice issues in our world is not a given. That basic respect for girls and women is not a given. That universal abhorrence of gender-based violence is not a given. We all have to work for it—even when (and especially when)—our lives are turned upside down.

Nurses are the most trusted professionals in both the U.S. and the U.K. (although tellingly, nursing was only added as a legitimate profession to these polls in the U.K. two years ago). As nurses, we have always prided ourselves on being truthful, for speaking out and advocating for our individual patients or communities. But for various reasons (including a lack of contemporary role models or inclusion in nursing curricula), nurses have not be so good at political advocacy and activism.

Historically, nursing does have some amazing examples of nurses who bucked the status quo, spoke truth to power—who were radical nurses. Florence Nightingale in the U.K.—and especially her work after the Crimean War in bringing nurses to work in poor/workhouses in England.  And in the U.S., my favorite historical role model is Lillian Wald in New York City. Lillian Wald founded the Henry Street Settlement in the poorest section of New York City, and she founded public health nursing. Public, community, population health nursing is what drew me to nursing in the first place and it continues to be my passion. Public health nursing work is always political work.

In the U.K. in the 1980s there was the short-lived but influential Radical Nurses Group (RNG). Some of their archived material was the subject of a (again, short-lived) blog, “The Radical Nurses Archive” written by a former NHS nurse using the lovely pseudonym, The Grumbling Appendix (with another blog on nursing and politics in the U.K. that ended in 2015).  Where have the radical nurses in the U.K. gone? I am currently on a quest to find them.

Back in the U.S. we have the NurseManifest website and resources on nursing and activism co-founded by Sue Hagedorn, Peggy Chinn, and Richard Cowling. Beginning in the summer of 2018, they have added the Nursing Activism Project with a growing list of historical and contemporary nurse activists “Inspirations for Activism.”  In addition, they have a dynamic list of resources for nurse activism.

No excuses. All you nurses out there in the world: Get informed. Get inspired. Get active.

I include a recent interview I had with my colleague here at Edinburgh Napier University School of Nursing and Social Care, Dr. Peter Hillen, on nursing and activism.